[Prognostic value of glomerular filtrate in acute coronary syndrome: Cockcroft's index or MDRD equation?]

Area of Science:

• Cardiology
• Nephrology
• Clinical Epidemiology

Background:

• Acute coronary syndrome (ACS) is frequently associated with kidney dysfunction.
• Approximately one-third of ACS patients exhibit kidney failure, a known predictor of adverse outcomes.

Purpose of the Study:

• To investigate the relationship between kidney failure and mortality in ACS patients.
• To compare the prognostic stratification capabilities of the Cockcroft-Gault (C-G) and MDRD-4 equations for kidney function in ACS.

Main Methods:

• A prospective study of 445 high-risk ACS patients admitted between 2006-2007.
• Patients were categorized based on kidney function (<60 mL/min/1.73 m² vs. ≥60 mL/min/1.73 m²) using C-G and MDRD-4 equations.
• Multivariate logistic regression analyzed the association between kidney function and 6-month mortality.

Main Results:

• Renal failure prevalence was 30.5% by C-G and 22.6% by MDRD-4.
• Patients with estimated glomerular filtration rate (GFR) < 60 mL/min/1.73 m² had significantly higher 6-month mortality.
• MDRD-4 equation demonstrated a stronger association with mortality (OR 3.372) compared to C-G (OR 2.652).

Conclusions:

• Kidney failure is a significant independent risk factor for 6-month mortality post-ACS.
• Both C-G and MDRD-4 equations are valuable for risk stratification, though MDRD-4 may offer superior prognostic accuracy.
• The choice of equation may depend on population characteristics, with similar performance for GFR between 60-80 mL/min.